The aim: Was assessment of the neurophysiological data and features of clinical picture in patients with neurogenic thoracic outlet syndrome (TOS). Materials and methods: 103 patients with upper extremity pain and/or paresthesia or hypotrophy, or a combination of these symptoms were examined. The examination algorithm included: cervical spine radiography, cervical spine and brachial plexuses magnetic resonance imaging (MRI), upper extremity soft tissues and vessels ultrasonic examination, stimulation electroneuromiography with F-waves registration. Results: Neurogenic TOS was diagnosed in 29 patients. A significant relationship between the following complaints and neurophysiological parameters was observed: pain, numbness during physical activity and decreased medial anrebrachial cutaneous nerve response amplitude by ≥25% compared to the contralateral side; hypothenar hypotrophy and decrease of ulnar nerve motor/sensory response amplitude; the 4-5th fingers hypoesthesia and decrease of ulnar nerve sensory response amplitude. Conclusions: Medial antebrachial cutaneous nerve amplitudes asymmetry indices of ≥25% or lack of response may be considered to be a marker of true neurogenic TOS.
Myofascial pain syndrome (MFPS) is one of the most common comorbid pathological processes that develops in skeletal muscle in patients with stroke, which is manifested by local seals and pain in various parts of the muscle. Despite the fact that the interest in MFPS arose in the last century, the intimate mechanisms of its development and course remain to be fully explored. It was found that the main manifestations of MFPS were the presence of miofascial trigger point in the area of palpation of the corresponding muscle with local pain and hypersensitivity within the palpated cord-segmentes, the characteristic pattern of reflected pain and reflected autonomic phenomenon, local convulsive response during transverse palpation. It is accompanied by muscle fatigue and significant muscle weakness without severe atrophy. Attention is drawn to the clear recurrence-reproducibility of pain, ie the so-called "recognizable" pain. All of the above symptoms constitute a general pattern of the disease, which has diagnostic value and is proposed for use as prognostic parameters with the obligatory use of the results of electromyographic examination. Diagnosis of active and latent MTP was performed on the basis of generally accepted l signs. The greatest discomfort for the patient is the presence of active MTP with characteristic spontaneously reproducing pain. Latent MTP is detected in up to 90% of cases among healthy people, and adverse factors only contribute to their transition to an active state with a characteristic symptom complex. The presence of an active myofascial trigger point with a characteristic spontaneously reproducing pain is the most painful manifestation. Latent MTP is also detected in most cases among healthy people, and unfavorable factors only contribute to their transition to an active state with a characteristic symptom complex. The study of the number of turns of the adhesive part of the potential in the zone of active ICC showed that there is a concentration of fibers in the zone of one motor units (MU). The average value of this indicator increases in the early stages of the process by 2 times. Even a small degree of desynchronization of the potentials of individual MU causes an increase in the number of rounds, which reflects the number of fibers involved in the generation of MC PMU. Absence of spontaneous muscle fibers (MF) activity, registration of end plate (EP) activity, PMU parameters such as amplitude decrease, shift of neurohistogram of potential distribution by duration towards smaller values or high percentage of polyphasicity, due to increase in number of turns, and also change their adhesive part, increase of MF density in zone MTP - they all determine changes in structural and functional parameters by muscle type. The work is devoted to the clinical, neuro-physiological characteristics of a patient with MFPS on the background of intracerebral hemorrhage and left hemyplegia based on the analysis of the neuro-functional organization of the motor units of the back muscles. Substantiated genesis and possible mechanism of development and formation of myofascial trigger point in such patients.
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